Medical Outcomes Survey Research Articles

Social Cognitive Predictors of Health Promotion Self-Efficacy Among Older Adults During the COVID-19 Pandemic.

To examine the relative importance of social cognitive predictors (ie, performance accomplishment, vicarious learning, verbal persuasion, affective state) on health promotion self-efficacy among older adults during COVID-19. Cross-sectional. Data collected online from participants in British Columbia (BC), Canada. Seventy-five adults (n = 75) aged ≥65years. Health promotion self-efficacy was measured using the Self-Rated Abilities for Health Practices Scale. Performance accomplishment was assessed using the health directed behavior subscale of the Health Education Impact Questionnaire; vicarious learning was measured using the positive social interaction subscale of the Medical Outcomes Survey - Social Support Scale (MOS-SSS); verbal persuasion was assessed using the informational support subscale from the MOS-SSS; and affective state was assessed using the depression subscale from the Depression Anxiety Stress Scale (DASS-21). Multiple linear regression was used to investigate the relative importance of each social cognitive predictor on self-efficacy, after controlling for age. Our analyses revealed statistically significant associations between self-efficacy and performance accomplishment (health-directed behavior; β = .20), verbal persuasion (informational support; β = .41), and affective state (depressive symptoms; β = -.44) at P < .05. Vicarious learning (β = -.15) did not significantly predict self-efficacy. The model was statistically significant (P < .001) explaining 43% of the self-efficacy variance. Performance accomplishment experiences, verbal persuasion strategies, and affective states may be the target of interventions to modify health promotion self-efficacy among older adults, in environments that require physical and social distancing.

Effectiveness of hybrid comprehensive telerehabilitation in women with heart failure - subanalysis of the TELEREH-HF RCT

Abstract Background Despite the known benefits of cardiac rehabilitation, it remains underutilized among women. In particular, little is known about the effectiveness of hybrid comprehensive telerehabilitation (HCTR) in women with heart failure (HF). Purpose: The purpose of this study was to assess effectiveness and safety of HCTR in women with HF. Methods: The present analysis formed part of TELEREH-HF multicenter, randomized trial that enrolled 850 HF patients (NYHA I-III, LVEF ≤ 40%). Patients were randomized 1:1 to HCTR plus usual care (UC) or UC alone. Patients underwent either an HCTR (1 week in hospital and 8 weeks at home, five times weekly) or UC with observation. The effectiveness of HCTR was assessed by changes in peak oxygen consumption (VO2 peak), workload duration (t) in cardiopulmonary exercise test and quality of life (QoL) based on Medical Outcome Survey Short Form 36 Questionnaire (SF-36). Measurements were made before and after intervention/observation. Results: Women constituted 11.5 % of population in the TELEREH-HF study. Forty women in HCTR group and 44 women in UC group completed HCTR and observation respectively. HCTR resulted in significant improvement in VO2peak, workload duration and QoL. We did not observe these favorable results in the UC group except for an increase workload duration. In the HCTR group, there was a significantly greater improvement in physical component of QoL than in the UC group. All results are presented in Table 1. In neither group were there deaths nor major adverse events related to exercise training. Conclusion In women with HF, hybrid comprehensive telerehabilitation is safe and resulted in a significant improvement in physical capacity and QoL.

Factors Affecting Daily Functioning in Turkish Patients with Obstructive Sleep Apnea.

Background and Objectives: This study aims to examine the factors affecting the daily functioning of patients with obstructive sleep apnea (OSA). Materials and Methods: In addition to the polysomnography records of 361 patients, participants completed the Turkish FOSQ-10 (Functional Outcomes of Sleep-10), Medical Outcome Survey Short Form-12, Epworth Sleepiness Scale (ESS), Beck Depression Inventory (BDI), and Beck Anxiety Inventory (BAI). First, the psychometrics properties of the Turkish FOSQ-10 were evaluated. Then, factors affecting daily functioning were examined through univariate and multivariate analyses. Results: Of all participants, 68.7% (n = 248) were male, and the average age was 47.94 ± 11.08. According to the OSA category, 23% (n = 83) were mild, 22.7% (n = 82) were moderate, 45.2% (n = 163) were severe, and 9.1% (n = 33) were OSA negative. The Turkish FOSQ-10 was found to be a valid and reliable scale through validity and reliability analyses. The moderate and severe OSA patients had different FOSQ-10 Total scores compared to the negative OSA group. Daily functioning was positively associated with overall quality of life while inversely associated with depression, being anxious, and daytime sleepiness in OSA patients. In a multiple regression model, BDI, mental component summary-12, physical component summary-12, and ESS scores were significantly related to the FOSQ-10 Total score in OSA patients (p < 0.05). Conclusions: The daily functioning of moderate and severe OSA patients was worse than that of the negative OSA group. Depression, quality of life, and daytime sleepiness were simultaneously important variables associated with daily functioning in OSA patients.

Patient Experience with Chronic Refractory Gout and Its Impact on Health-Related Quality of Life: Literature Review and Qualitative Analysis.

Patients with chronic refractory gout face a considerable burden of disease due to unexpected flares characterized by severe and debilitating pain, which can lead to chronic pain and joint damage. This study aimed to understand the symptoms and impacts of chronic refractory gout on health-related quality of life (HRQoL). A targeted literature review was conducted to identify and review key articles describing the symptoms and impacts of gout, and articles examining the psychometric performance of the Medical Outcomes Survey Short Form-36 (SF-36) and Health Assessment Questionnaire-Disability Index (HAQ-DI) in gout. Qualitative interviews were conducted with 20 participants with chronic refractory gout. The results were used to develop the conceptual model and determine the appropriateness of the SF-36 and HAQ-DI in evaluating HRQoL in this population. Most frequently reported symptoms included bodily pain (n = 18, 90.0%), joint swelling (n = 18, 90.0%), joint tenderness (n = 18, 90.0%), and joint pain (n = 16, 80.0%). Most frequently reported impacts were difficulties climbing a flight (n = 20, 100.0%) or several flights of stairs (n = 20, 100.0%), climbing five steps (n = 19, 95.0%), completing chores (n = 19, 95.0%), and running errands and shopping (n = 19, 95.0%). All assessed items from SF-36 and HAQ-DI were reported by ≥ 25% (n = 5) of participants and mapped sufficiently to concepts elicited by participants. Patients with chronic refractory gout report symptoms and impacts that are highly bothersome and burdensome to everyday life. Items included in the HAQ-DI and SF-36 mapped directly to these symptoms and impacts and are relevant to understand the burden of disease of chronic refractory gout.

Correlation of self-management and social support with quality of life in patients with chronic kidney disease undergoing hemodialysis: A cross-sectional study from Kerala, India

IntroductionChronic Kidney Disease (CKD) is a progressive condition that impacts the quality of life (QOL) of individuals worldwide. However, the role of self-management and social support among CKD patients on their QOL remains understudied in India. Therefore, this study aims to find the correlation of self-management and social support on the QOL of CKD patients undergoing hemodialysis. MethodsThis hospital-based cross-sectional study involved 110 adult CKD patients (mean (SD) age of 56 (±13.9) years, 73 % men) undergoing hemodialysis in two tertiary care hospitals in Ernakulam district. Face-to-face interviews with questionnaires, including World Health Organisation Quality of Life- Brief Version (WHOQOL-BREF), Medical Outcome Survey – Social Support Survey (MOS-SSS), and Hemodialysis Self-Management Instrument-18 (HDSMI-18) were used. Pearson correlation and simple linear regression analysis were done to find the correlation between self-management and social support with QOL. FindingsThe mean (SD) QOL score was 56.27 (11.62), with the environment domain rating highest [62.47 (14.02)] and social relations lowest [52.12 (18.52)]. Mean (SD) self-management score was 41.12 (5.66) and mean (SD) social support score was 65.28 (18.21). Self-management (r = 0.382, p = 0.001) and social support (r = 0.309, p = 0.001) showed a moderate positive correlation with QOL. DiscussionSelf-management and social support were moderately correlated with QOL. Strengthening self-management programs and social support networks are likely to improve the QOL of CKD patients undergoing hemodialysis.

Motor and sensory impairment in survivors of childhood central nervous system (CNS) tumors in the St. Jude Lifetime Cohort (SJLIFE).

Survivors of childhood central nervous system (CNS) tumors can develop motor and sensory impairment from their cancer and treatment history. We estimated the prevalence of motor and sensory impairment in survivors compared with controls through clinical assessment and identified associated treatment exposures and functional, quality of life (QOL), and social outcomes. Survivors of childhood CNS tumors from the St. Jude Lifetime Cohort (n = 378, median [range] age 24.0 [18.0-53.0] years, 43.4% female) ≥5 years from diagnosis and controls (n = 445, median [range] age 34.0 [18.0-70.0] years, 55.7% female) completed in-person evaluation for motor and sensory impairment using the modified Total Neuropathy Score. Impairment was graded by modified Common Terminology Criteria for Adverse Events. Multivariable models estimated associations between grade ≥2 motor/sensory impairment, individual/treatment characteristics, and secondary outcomes (function by Physical Performance Test, fitness by physiologic cost index, QOL by Medical Outcomes Survey Short Form-36 physical/mental summary scores, social attainment). Grade ≥2 motor or sensory impairment was more prevalent in survivors (24.1%, 95% Confidence Interval [CI] 19.8%-29.4%) than controls (2.9%, CI 1.4-4.5%). Among survivors, in multivariable models, motor impairment was associated with vinca exposure <15 mg/m2 versus none (OR 4.38, CI 1.06-18.08) and etoposide exposure >2036 mg/m2 versus none (OR 12.61, CI 2.19-72.72). Sensory impairment was associated with older age at diagnosis (OR 1.09, CI 1.01-1.16) and craniospinal irradiation versus none (OR 4.39, CI 1.68-11.50). There were lower odds of motor/sensory impairment in survivors treated in the year 2000 or later versus before 1990 (Motor: OR 0.29, CI 0.10-0.84, Sensory: OR 0.35, CI 0.13-0.96). Motor impairment was associated with impaired physical QOL (OR 2.64, CI 1.22-5.72). In survivors of childhood CNS tumors, motor and sensory impairment is prevalent by clinical assessment, especially after exposure to etoposide, vinca, or craniospinal radiation. Treating motor impairment may improve survivors' QOL.

Insight into quality of life: Understanding the experience of patients with cancer in southern Brazil's public healthcare system.

e23223 Background: This study explores the quality of life of individuals undergoing cancer treatment in the southern region of Brazil within the public healthcare system. Recognizing the potential negative impacts of both the disease and its treatment on patients' well-being, there is a pressing need to comprehensively assess their quality of life. The study aims to understand the challenges faced by these individuals in various well-being dimensions. Methods: Data collection occurred from August 1, 2023, to December 31, 2023, approved by the Ethics and Research Committee (Opinion Number: 6,136,833). Quality of life was assessed using the Brazilian version of the Medical Outcome Survey Short-Form 36 (SF-36), a validated instrument comprising 11 questions. Inclusion criteria included individuals over 18, of any gender, residing in the southern region if the state of Espirito Santo, diagnosed with cancer, and receiving treatment at the public healthcare reference oncology center. Exclusion criteria encompassed those under 18, non-residents of southern region, lacking a cancer diagnosis and undergoing oncohematological treatments. Among 263 eligible participants, 21 were excluded for not meeting inclusion criteria and 16 invited individuals chose not to participate, resulting in a final sample of 226 individuals. Results: The composition of the participant pool comprised 71.6% women and 28.4% men. The evaluation of quality of life utilized the SF-36 instrument, which explores various domains: Functional Capacity, Limitation due to Physical Aspects, Pain, General Health Status, Vitality, Social Aspects, Emotional Aspects, and Mental Health.Functional Capacity saw 44.20% facing significant difficulties, 32.80% experiencing mild difficulties, and 23% reporting no hindrance in daily activities. Physical limitations due to cancer treatment were reported by 61%, while 39% did not face such limitations. Most patients experienced some level of pain; only 24.20% were pain-free. General Health Status varied from excellent (9.10%) to very bad (2%). Vitality fluctuated, with 31% reporting vitality all the time. Regarding the social dimension, most individuals experience interference, while only 37% report no impact.Emotional aspects interfered with daily life for 59% of participants. Conclusions: This research indicates that both physical and emotional aspects are significantly affected in cancer patients from southern Espírito Santo. While physical limitations and pain are prevalent, emotional aspects, including manifestations of anxiety and depression, also play a substantial role in influencing daily life. Understanding these dimensions is vital for developing targeted interventions, especially for vulnerable individuals relying on Brazil's public healthcare system, to enhance the quality of life during cancer treatment.

Device-specific quality of life: Results from the ATLAS trial-Avoid Transvenous Leads in Appropriate Subjects.

Patient reported outcomes (PROs) provide important insights into patients' acceptance of their medical devices. ATLAS, a randomized, multi-center, open-label clinical trial, recently reported fewer perioperative complications in S-ICD compared to TV-ICD patients. This study reports PROs, including device-specific and generic quality of life (QOL) from the ATLAS trial. Device-specific QOL was the primary PRO using the Florida Patient Acceptance Survey (FPAS) at 1-and 6-months post-implantation. Secondary outcomes included generic QOL using the Medical Outcomes Survey (SF-36) pre-implant and 6-months post-implantation. FPAS and SF-36 were analyzed using ANCOVA. Pain measured using a Numeric Rating Scale, at 1-and 6-months, anesthetic, BMI and within/between differences were analyzed using descriptive statistics and mixed-effects linear models (MLM). Of the 503 patients randomized in ATLAS, 404 had complete FPAS data to include in this analysis. Participant characteristics were balanced. There were no significant differences between S-ICD and TV-ICD for FPAS or SF-36, across timepoints. Mean total FPAS scores increased from 73.73 (16.09) to 77.05 (16.13) and 74.43 (15.35) to 78.25 (15.88) for S-ICD and TV-ICD, respectively, (p <0.001). PROs suggested that both devices were associated with good QOL. Device-specific and generic QOL were similar between S-ICD and TV-ICD groups up to 6-months post-implantation indicating that regardless of device type, both groups reported good device specific QOL in ATLAS patients. S-ICD patients reported higher pain scores at implant, but pain decreased by 6 months. The findings offer evidence that can be included during shared decision-making. The inclusion of patient partners in ATLAS provided opportunity to measure PROs that were deemed important to patients.

Validation of the Italian version of a patient-reported outcome measure for Hereditary Spastic Paraplegia.

Patient-reported outcome measures (PROMs) are recognized as valuable measures in the clinical setting. In 2018 we developed the Italian version of the "Hereditary Spastic Paraplegia-Self Notion and Perception Questionnaire" (HSP-SNAP), a disease-specific questionnaire that collects personal perception on motor symptoms related to HSP such as stiffness, weakness, imbalance, reduced endurance, fatigue and pain. In this study our primary aim was to assess the questionnaire validity and reliability. Our secondary aim was to characterize the symptoms "perceived" by patients with HSP and compare them with those "perceived" by age-matched healthy subjects. The 12-item HSP-SNAP questionnaire was submitted to 20 external judges for comprehensibility and to 15 external judges for content validity assessment. We recruited 40 subjects with HSP and asked them to fill the questionnaire twice for test-retest procedure. They also completed the Medical Outcome Survey Short Form (SF-36) and were evaluated by the Spastic Paraplegia Rating Scale and the Six-Minute Walk Test. We also recruited 44 healthy subjects who completed the HSP-SNAP once to test score variability. The HSP-SNAP content validity index was high (0.8±0.1) and the test-retest analysis showed high reliability (ICC = 0.94). The mean HSP-SNAP score (score range 0-48) of the HSP group was 22.2±7.8, which was significantly lower than healthy subjects (43.1±6.3). The most commonly perceived symptom was stiffness, followed by weakness and imbalance. Although HSP-SNAP does not investigate non-motor symptoms and we validated only its Italian version, it showed good validity and reliability and it could be used in combination with other objective outcome measures for clinical purposes or as endpoints for future clinical rehabilitation studies. Trial Registration: ClinicalTrial.gov, NCT04256681. Registered 3 February 2020.

Health-Related Quality of Life Across the Spectrum of Pulmonary Hypertension

BackgroundHealth related quality of life (HRQOL) is frequently impaired in pulmonary arterial hypertension (PAH). However, little is known about HRQOL in other forms of pulmonary hypertension (PH). Research QuestionDoes HRQOL vary across groups of the World Symposium on Pulmonary Hypertension (WSPH) classification system? Study Design and MethodsThis cross-sectional study included PH patients from PVDOMICS (Pulmonary Vascular Disease Phenomics). HRQOL was assessed using emPHasis-10 (e-10), Medical Outcomes Survey Short Form-36 (SF-36; physical component (PCS) and mental component (MCS)), and Minnesota Living with Heart Failure Questionnaire (MLHF). Pearson’s correlations between HRQOL and demographic, physiologic, and imaging characteristics within each WSPH group were tested. Multivariable linear regressions compared HRQOL across WSPH groups adjusting for demographics, disease prevalence, functional class, and hemodynamics. Cox proportional hazard models were used to assess associations between HRQOL and survival across WSPH groups. ResultsAmong 691 PH patients, HRQOL correlated with functional class and six-minute walk distance but not hemodynamics. HRQOL was severely depressed across WSPH groups for all measures except the SF-36 MCS. When compared to Group 1, Group 2 subjects had significantly worse HRQOL (e-10: 29 vs 24, p=0.001, PCS: 32.9 ± 8 vs 38.4 ± 10, p<0.0001, MLHF: 50 vs 38, p=0.003). Group 3 subjects similarly had worse e-10 (31 vs 24, p<0.0001) and PCS scores (33.3 ± 9 vs 38.4 ± 10, p<0.0001) compared to Group 1, which persisted in multivariable models (p<0.05). HRQOL was associated in adjusted models with survival across Groups 1, 2, and 3. InterpretationHRQOL is depressed in PH and particularly in Groups 2 and 3 despite less severe hemodynamics. HRQOL is associated with functional capacity, but hemodynamic disease severity poorly estimates the impact of PH on patient’s lives. Further studies are needed to better identify predictors and treatments to improve HRQOL across the spectrum of pulmonary hypertension.

Effectiveness of hybrid comprehensive telerehabilitation in heart failure patients with permanent atrial fibrillation - subanalysis of the TELEREH-HF RCT

Abstract Background Atrial fibrillation (AF) negatively impacts physical fitness and quality of life (QoL). Little is known about efficacy of hybrid comprehensive telerehabilitation (HCTR) in heart failure (HF) patients with AF. Purpose The purpose of this study was to assess safety and effectiveness of HCTR in HF patients with permanent AF. Methods The present analysis formed part of TELEREH-HF multicenter, randomized trial that enrolled 850 HF patients (NYHA I-III, LVEF ≤ 40%). Patients were randomized 1:1 to HCTR plus usual care (UC) or UC alone. Patients underwent either an HCTR (1 week in hospital and 8 weeks at home, five times weekly) or UC with observation. The effectiveness of HCTR was assessed by changes in peak oxygen consumption (VO2 peak), workload duration (t) in cardiopulmonary exercise test and quality of life (QoL) based on Medical Outcome Survey Short Form 36 Questionnaire (SF-36). Measurements were made before and after intervention/observation. Results There were 73 patients with permanent AF in HCTR group and 72 patients with permanent AF in UC group. HCTR resulted in a significant improvement in VO2peak and workload duration. We did not observe these favorable results in the UC group. In the HCTR group, there was a significantly greater improvement in physical component of QoL than in the UC group. All results are presented in Table 1. In neither group were there deaths nor major adverse events. Conclusion In HF patients with permanent AF, hybrid comprehensive telerehabilitation is safe and resulted in a significant improvement in physical capacity and physical component of QoL.

4 Neurophenotypes and recovery trajectories following laboratory-confirmed SARS-CoV-2 infection

Objective:Cognitive sequelae are reported in 20-25% of patients following SARS-CoV-2 infection. It remains unclear whether post-infection sequelae cluster into a uniform cognitive syndrome. In this cohort study, we characterized post-COVID neuropsychological outcome clusters, identified factors associated with cluster membership, and examined 6-month recovery trajectories by cluster.Participants and Methods:The Mayo Clinic Institutional Review Board approved study protocols. Informed consent was obtained from all participants. Participants (&gt; 18 years old) were recruited from a hospital-wide registry of Mayo Clinic Florida patients who tested positive for SARS-CoV-2 infection from July 2020 to Feb 2022. We abstracted participant health history and COVID-19 disease severity (NIAID score) from the electronic health record and retrieved Area Deprivation Index (ADI) scores as a measure of neighborhood socioeconomic disadvantage. We assessed objective cognitive performance with the CNS Vital-Signs (CNSVS) and subjective neuropsychological symptoms with the Neuropsych Questionnaire-45 (NPQ-45). Results were used as input features in a K-means clustering analysis to derive neurophenotypes. Chi-square and analysis of variance (AnOvA) tests were used to identify clinical and sociodemographic factors associated with cluster membership. Participants repeated the CNS Vital Signs, NPQ-45, as well as the Medical Outcomes Survey (MOS SF-36) and a posttraumatic stress disorder (PTSD) checklist (PCL-C 17) 6 months following initial testing. Repeated-measures ANOVA was used to assess change in neurocognitive performance over time by cluster. Significance was set at P &lt; 0.05.Results:Our cohort consisted of 205 participants (171 ambulatory, 34 hospitalized) who completed post-acute outcome assessment a mean of 5.7 (± 3.8) weeks following testing positive for SARS-CoV-2. K-means clustering with elbow method fitting identified three subgroups (see figure). The first cluster (N = 31) is characterized by executive dysfunction, greater socioeconomic disadvantage, and higher rates of obesity. The second cluster (N = 32) is characterized by memory and speed impairment, higher COVID severity, prevalent anosmia (70%), and greater severity of memory complaints, depression, anxiety, and fatigue. The third and largest cluster (N = 142) is absent cognitive impairment. Approximately 39% of participants completed the 6-month outcome assessment (N=79). Regardless of cluster membership, verbal memory, psychomotor speed, and reaction time scores improved over time. Regardless of timepoint, cluster 1 (dysexecutive) showed lower scores on cognitive flexibility and complex attention and cluster 2 (memory-speed impaired) showed lower scores on verbal memory, psychomotor speed, and reaction time. Modeling of cluster by timepoint interactions showed a steeper slope of improvement in complex attention and cognitive flexibility in cluster 1 (dysexecutive). Cluster 3 (normal) showed significant improvement in fatigue while cluster 2 (memory-speed impaired) continued to report moderate-severe fatigue, worse medical outcomes, and higher PTSD symptom severity scores at six months.Conclusions:Most participants were cognitively normal or experienced cognitive recovery following SARS-CoV-2 infection. The 25-30% of participants who showed cognitive impairment cluster into two different neurophenotypes. The dysexecutive phenotype was associated with socioeconomic factors and medical comorbidities that are non-specific to COVID-19, while the amnestic phenotype was associated with COVID-19 severity and anosmia. These results suggest that cognitive sequelae following SARS-CoV-2 infection are not uniform. Deficits may be influenced by distinct patient- and disease-specific factors, necessitating differentiated treatment approaches.

Retraction speed and chronic poststernotomy pain: A randomized controlled trial

ObjectivesApproximately 30% of patients develop chronic poststernotomy pain (CPSP) following cardiac surgery with sternal retraction. Risk factors have been described but no causal determinants identified. Investigators hypothesized that opening the sternum slowly would impart less force (and thereby less nerve/tissue damage) and translate to a reduced incidence of CPSP. The main objectives were to determine whether or not slower sternal retraction would reduce the incidence of CPSP and improve health-related quality of life. MethodsPatients undergoing coronary artery bypass graft surgery were recruited to this randomized controlled trial. Patients were randomized to slow or standard retraction (ie, sternum opened over 15 minutes vs 30 seconds, respectively). Although the anesthesiologist and surgeon were aware of the randomization, the patients, assessors, and postoperative nursing staff remained blinded. Sternotomy pain and analgesics were measured in hospital. At 3, 6, and 12 months postoperatively, all patients completed the Medical Outcomes Survey Short Form and reported on CPSP and complications requiring rehospitalization. Thirty-day rehospitalizations and mortality were recorded. ResultsIn total, 326 patients consented to participate and 313 were randomized to slow (n = 159) versus standard retraction (n = 154). No clinically relevant differences were detected in acute pain, analgesic consumption, or the incidence of CPSP or health-related quality of life. Although the slow group had significantly more hospitalizations at 3 and 12 months postoperatively, the reasons were unrelated to retraction speed. No differences were observed in 30-day rehospitalizations or mortality. ConclusionsAll outcomes were consistent with previous reports, but no clinically significant differences were observed with retraction speed.

The role of posttraumatic cognitions in integrated treatments for co-occurring posttraumatic stress disorder and alcohol use disorder.

Posttraumatic cognitions are a mechanism of posttraumatic stress disorder (PTSD) symptom reduction in trauma-focused interventions for PTSD. It is unclear how changes in posttraumatic cognitions are associated with important clinical correlates of PTSD, including drinking and psychosocial functioning. This study examined if changes in posttraumatic cognitions during integrated treatment for co-occurring PTSD/alcohol use disorder (AUD) were associated with concurrent improvements in PTSD severity, heavy drinking, and psychosocial functioning. One hundred nineteen veterans (65.5% white and 89.9% men) with PTSD/AUD randomized to receive Concurrent Treatment of PTSD and Substance Use Disorders using Prolonged Exposure or Seeking Safety completed assessments of posttraumatic cognitions (Posttraumatic Cognitions Inventory), PTSD severity (Clinician-Administered PTSD Scale for DSM-5), drinking (Timeline Followback), and psychosocial functioning (Medical Outcomes Survey SF-36) at baseline, posttreatment, 3- and 6-month follow-up. Structural equation models indicated that posttraumatic cognitions improved significantly during treatments for PTSD/AUD with no significant treatment differences. Reductions in posttraumatic cognitions during treatment were associated with concurrent improvements in PTSD severity and functioning, and differentially associated with drinking. Findings suggest that changes in posttraumatic cognitions in integrated treatments for PTSD/AUD are not solely important for symptom change but are implicated in improvements in functioning. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Association of emotional support with quality of life, mental health, and survival among older adults with gastrointestinal (GI) malignancies.

12050 Background: Emotional support (ES) is the most frequently reported support need among older adults with cancer. Yet, the association of ES with cancer outcomes is largely unknown. This study examined the association of ES with health-related quality of life (HRQoL), mental health, and survival among older adults with GI malignancies. Methods: We included older adults (≥60y) newly diagnosed with GI cancer and undergoing a self-reported geriatric assessment (GA) at first clinic visit. Self-reported ES, measured by the Medical Outcomes Survey was the primary exposure. Outcomes included physical and mental HRQoL as measured by the Patient-Reported Outcomes Measurement Information System® (PROMIS) 10-item global assessment, anxiety and depression as measured by the PROMIS Anxiety and Depression Short Form 4a, respectively, and one-year, two-year, and overall survival. Linear regression evaluated the association between ES and t-scores of physical/mental HRQoL. Logistic regression evaluated the association of ES with anxiety and depression. Models were adjusted for age, race, sex, and cancer type/stage. Kaplan-Meier curves and log-rank tests evaluated the association between ES and survival outcomes. Results: Overall, 795 participants were included. The median age was 68 (IQR: 64-74) and patients were 58.0% male, and 74.6% White. The most common cancers included colorectal (37.9%) and pancreatic (30.8%), with mostly advanced staged disease (Stage III/IV: 72.1%). A majority (77.6%) had adequate ES. Patients with inadequate ES were more likely to be Black (31.5 vs. 20.8%, p=0.005), disabled (24.1 vs. 10.4%, p&lt;0.001), and widowed/divorced (54.2 vs. 24.8%, p&lt;0.001). After adjustment, patients with inadequate ES had lower physical and mental HRQoL t-scores (Physical β: -3.35, 95% CI: -5.25, -1.46; Mental β: -2.46, 95% CI: -4.11, -0.81) and higher odds of depression (aOR: 2.22, CI: 1.34-3.69). There was no statistically significant association with anxiety (aOR:1.15, CI: 0.73, 1.81). No differences were observed between patients with inadequate versus adequate ES in one-year, two-year, or overall survival (Log-Rank tests: one-year, p=0.952; two-year, p=0.606; overall, p=0.584). Conclusions: Older adults with inadequate ES have higher odds of poor physical and mental HRQoL and depression, but no difference in survival compared to those with adequate ES. Further work is necessary to determine if interventions to improve ES also improve HRQoL and depression.

0078 Subjective but not objective sleep predicts morning motivation to complete more difficult tasks

Abstract Introduction Sleep deprivation impairs many facets of behavior, including performance at tasks. People may perform less efficiently at tasks due to impairments to cognitive processes like working memory following sleep deprivation. However, research shows that compensatory activity occurs when participants are sleep deprived and are faced with difficult tasks (Horne &amp; Pettitt, 1985). This study explored participants’ capability and motivation of completing tasks of varying difficulties. Methods These data come from a larger study investigating bedroom environment, sleep, and cognition. In this study participants were given an actigraph wgt3x and were told to sleep as they normally would for three-day period. Each morning, participants took a brief survey and cognitive battery shortly after waking. In the survey, participants self-reported their sleep quality from the previous night using a modified version of the sleep disturbance subscale from the Medical Outcomes Survey (Hays et al., 2005). Additionally, a modified version of the Math Effort Task (MET; Engle Friedman et al., 2003) was used. Participants chose a difficulty and completed six simple addition problems without aid of a calculator or scratch paper. Data were cleaned and analyzed using generalized linear mixed effect modeling in SPSS 28. Results Two models were run to examine performance (accuracy) and difficulty choice on the MET. In our model predicting performance there were no significant predictors. In our model predicting the choice of difficulty, participants of more socially advantaged populations and those who reported better subjective sleep quality chose to complete harder problems (b = -.05, p = .01). No significant findings were observed between objective measures of sleep such as sleep efficiency and duration with difficulty chosen or performance. Conclusion Motivation to complete more difficult tasks may be related to the quality of sleep one receives during the previous night. The observed lack of difference in performance based on sleep suggest that when given simple problems, sleep deprivation does not impair cognitive performance or that people can compensate for poor sleep when the task is easy. Future studies should continue to explore the relationship between sleep and motivation. Support (if any) I/O small grant department funding, university research funding, and travel funding.

Risks of adverse perinatal outcomes in relation to maternal depressive symptoms: A prospective cohort study in Kenya.

Evidence gaps remain regarding the influence of prenatal psychosocial factors on adverse pregnancy outcomes. The objective of this study is to evaluate relationships between psychosocial factors and adverse perinatal outcomes among Kenyan women. We analysed data from a prospective cohort study enrolling HIV-negative women in pregnancy (NCT03070600) in 20 antenatal clinics in Western Kenya. Study nurses assessed depressive symptoms using the Center for Epidemiologic Studies Depression Scale (CESD-10), social support using the Medical Outcomes Survey scale (MOS-SSS), intimate partner violence (IPV) with the Hurt, Insult, Threaten, Scream scale (HITS), and pregnancy outcomes at 6 weeks postpartum. Cox proportional hazards models were used to evaluate relationships between depressive symptoms (moderate-to-severe [MSD, CESD-10 ≥10] and mild-to-severe [Mild-SD, CESD-10 ≥5]), low social support (MOS-SSS <72), and IPV (HITS ≥10) with adverse perinatal outcomes of pregnancy loss, stillbirth, preterm birth (PTB), small for gestational age, and neonatal mortality. We also estimated the population attributable risk. Among 4153 women, 23.9% (n = 994) had MSD, 54.7% (n = 2273) mild-SD, 37.3% (n = 1550) low social support, and 7.8% (n = 323) experienced IPV. Pregnancy loss was 5-fold higher among women with MSD (adjusted hazard ratio [HR] 5.04, 95% confidence interval [CI] 2.44, 10.42); 37.4% of losses were attributable to MSD. Mild-SD was associated with PTB (HR 1.39, 95% CI 1.03, 1.87). Stillbirth risk more than doubled among women reporting low social support (HR 2.37, 95% CI 1.14, 4.94). Adverse perinatal outcomes were common and associated with prenatal depressive symptoms and low social support in this large cohort of Kenyan mother-infant pairs.

Comparisons of SLE-DAS and SLEDAI-2K and classification of disease activity based on the SLE-DAS with reference to patient-reported outcomes.

Although the SLE Disease Activity Score (SLE-DAS) and its definitions to classify disease activity have been recently developed to overcome the drawbacks of the SLE Disease Activity Index 2000 (SLEDAI-2K), the performance of the SLE-DAS for patient-reported outcomes (PROs) has not been fully examined. We aimed to compare SLE-DAS with SLEDAI-2K and validate the classifications of disease activity based on SLE-DAS in terms of PROs. We assessed generic quality of life (QoL) using the Medical Outcome Survey 36-Item Short-Form Health Survey (SF-36), disease-specific QoL using the lupus patient-reported outcome tool (LupusPRO), burden of symptoms using the SLE Symptom Checklist (SSC), patient global assessment (PtGA) and physician global assessment (PhGA). Of the 335 patients with SLE, the magnitudes of the mean absolute error, root mean square error, Akaike information criterion, and Bayesian information criterion were comparable for most PROs between the SLE-DAS and SLEDAI-2K. In contrast, SLEDAI-2K had a higher predictive value for health-related QoL of LupusPRO and PtGA than SLE-DAS. Low disease activity, Boolean and index-based remission and categories of disease activity (remission, mild and moderate/severe activity) were significantly associated with health-related QoL in LupusPRO, SSC and PhGA, but not SF-36 or PtGA. No clear differences were identified in the use of the SLE-DAS over the SLEDAI-2K in assessing PROs in patients with SLE. The classification of disease activity based on the SLE-DAS was validated against several PROs. SLE-DAS and its categories of disease activity effectively explain some of the PROs.

A Multi-Center, Open-Label Exploratory Study to Assess Cognitive Function Response to Lifestyle Changes Plus Supplementation in Healthy Adults with Risk Factors Associated with Cognitive Decline

PreCODE is a multifaceted protocol that applies lifestyle modifications to improve cognitive decline. NeuroQ is a blend of ingredients that have been individually reported to benefit cognition. The objective of this open-label exploratory study was to evaluate the efficacy of PreCODE with NeuroQ on cognition in healthy adults with risk factors for cognitive decline. Thirty participants ≥45 years at-risk of cognitive decline underwent PreCODE with NeuroQ. Cognitive function was assessed by CNS-Vital Signs (CNS-VS) at 30, 60 and 90 days. Quality of life (QoL), sleepiness, depression, and healthy habits were assessed with the Medical Outcomes Survey, Epworth Sleepiness Scale, Patient Health Questionnaire, and Life Habits Checklist, respectively. There was a 10, 12, and 14% increase in the neurocognitive index percentile scores from screening at Day 30, 60, and 90, respectively (p ≤ 0.01). The CNS-VS domains in psychomotor-, processing-, and motor-speed, complex- and sustained-attention, reaction time, cognitive flexibility, executive function, and working memory improved at Day 90 (p ≤ 0.04). Executive function, cognitive flexibility, processing speed, and working memory, improved by 12, 11, 10, and 7%, respectively, at Day 90. There were improvements in QoL, daytime sleepiness, depression, and lifestyle habits (p ≤ 0.014). NeuroQ was safe and well tolerated. PreCODE with NeuroQ improved cognitive function and QoL in adults at-risk of cognitive decline. Placebo- or comparator-controlled studies are warranted to confirm the effect on cognitive function.

Minimal Clinically Important Difference in the 6-minute-walk Distance for Patients with Pulmonary Arterial Hypertension.

Rationale: The 6-minute-walk distance (6MWD) is an important clinical and research metric in pulmonary arterial hypertension (PAH); however, there is no consensus about what minimal change in 6MWD is clinically significant. Objectives: We aimed to determine the minimal clinically important difference in the 6MWD. Methods: We performed a meta-analysis using individual participant data from eight randomized clinical trials of therapy for PAH submitted to the U.S. Food and Drug Administration to derive minimal clinically important differences in the 6MWD. The estimates were externally validated using the Pulmonary Hypertension Association Registry. We anchored the change in 6MWD to the change in the Medical Outcomes Survey Short Form physical component score. Measurements and Main Results: The derivation (clinical trial) and validation (Pulmonary Hypertension Association Registry) samples were comprised of 2,404 and 537 adult patients with PAH, respectively. The mean ± standard deviation age of the derivation sample was 50.5 ± 15.2 years, and 1,849 (77%) were female, similar to the validation sample. The minimal clinically important difference in the derivation sample was 33 meters (95% confidence interval, 27-38), which was almost identical to that in the validation sample (36 m [95% confidence interval, 29-43]). The minimal clinically important difference did not differ by age, sex, race, pulmonary hypertension etiology, body mass index, use of background therapy, or World Health Organization functional class. Conclusions: We estimated a 6MWD minimal clinically important difference of approximately 33 meters for adults with PAH. Our findings can be applied to the design of clinical trials of therapies for PAH.